Current and future public health is characterized by the increase of chronic and degenerative diseases, corresponding to the worldwide ageing of the population. The increasing prevalence of these conditions together with the long incubation period of the chronic diseases and the continual technological innovations, offer new opportunities to develop strategies for early diagnosis.
Public Health has an important mandate to critically assess the promises and the pitfalls of disease screening strategies. This MOOC will help you understand important concepts for screening programs that will be explored through a series of examples that are the most relevant to public health today. We will conclude with expert interviews that explore future topics that will be important for screening.
By the end of this MOOC, students should have the competency needed to be involved in the scientific field of screening, and understand the public health perspective in screening programs.
This MOOC has been designed by the University of Geneva and the University of Lausanne.
This MOOC has been prepared under the auspices of the Ecole romande de santé publique (www.ersp.ch) by Prof. Fred Paccaud, MD, MSc, Head of the Institute of Social and Preventive Medicine in Lausanne (www.iumsp.ch), in collaboration with Professor Antoine Flahault, MD, PhD, head of the Institute of Global Health, Geneva (https://www.unige.ch/medecine/isg/en/) and Prof. Gillian Bartlett-Esquilant (McGill University, Quebec/ Institute of Social and Preventive Medicine, Lausanne).

From the lesson

Evaluation, Planning, Implementation and the Future of Screening Programs

In this final module, important aspects of for the evaluation, planning and decision making about the implementation or stopping of screening programs will be presented. This material is given by Senior lecturer Jean-Luc Bulliard who is an epidemiologist in the Division of Chronic Diseases at the Institute for Social and Preventive Medicine in Lausanne. The conclusion of the module will be a series of interviews with experts on the future of disease screening in public health conducted by Dr. Gillian Bartlett-Esquilant, a visiting professor at the Institute for Social and Preventive Medicine at Lausanne. A quiz will close this module.

Meet the Instructors

Antoine Flahault

Professor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes)University of Geneva and Université Paris Descartes – Sorbonne Paris Cité

Fred Paccaud (In Partnership with UNIGE)

Professor of epidemiology and public health and Director of the Institute of social and preventive medicineLausanne University Hospital

Gillian Bartlett-Esquilant

Professor of Epidemiology and Research and Graduate Program Director and Associate Chair for the Department of Family Medicine at McGill University.University of Lausannne and McGill University

The canton of Vaud in Switzerland has planned a Colorectal cancer screening program.

And as part of the planning of this program,

it has been decided to offer to

the population the choice between two modalities of screening,

a fecal immunological test to be done every two years,

or colonoscopy to be performed every 10 years.

This choice between two tests has led to the inclusion

of a free consultation with the primary practitioner as part of the screening program.

During these consultations, the GP can

explain to the patient the advantage and disadvantage of both tests

so the patient can decide first if he wants,

or she wants to be screened, and if so,

which test he or she will prefer.

There's quite another approach which has necessitated the development of

several decision aid boxes to help the GPs

and the patients in making their decisions.

As you can see in the decision box here,

there are all possible outcomes of screening,

whether favorable or not which have displayed.

In the upper part,

it is about people who choose to do the FIT test.

What happened to a population of people opting for FIT test.

In the lower part,

you have the same descriptions for people who may prefer to choose a colonoscopy.

So, the decision box, first is color coded,

so you can see the role of each of the patterns,

which is the population,

which is screening center,

which part is from the primary care physicians, the gastroenterologist.

Just an example decision box which have been developed by

a multidisciplinary team including gastroenterologist,

primary care physicians, and immunologists.

The patient can for instance see and understand

that a colonoscopy is only needed if the FIT test is positive.

It can realize what is a high risk of being diagnosed with cancer,

or effects on prognosis with different tests can see that colonoscopy for instance,

is more likely to pick up cancer or advanced adenomas.

It can also look at harms of screening with

a chance of suffering from complications from a colonoscopy for instance,

or the chance that a test may miss the cancer.

So, it is also useful for a GP to explain over

a context and colonoscopy as a higher risk of harm,

and bear some stronger inconvenience such as bowel cleansing before the exam,